Tuesday, April 19, 2016

“Bureaucracy & Beliefs”: Assessing the Barriers to Accessing Opioid Substitution Therapy by People Who Inject Drugs in Ukraine

Aims

Opioid substitution therapy
(OST) is an evidence-based HIV prevention strategy for people who inject drugs
(PWIDs). Yet, only 2.7% of Ukraine’s estimated 310,000 PWIDs receive it despite
free treatment since 2004. The multi-level barriers to entering OST among
opioid dependent PWIDs have not been examined in Ukraine.

Methods

A multi-year mixed methods
implementation science project included focus group discussions with 199 PWIDs
in 5 major Ukrainian cities in 2013 covering drug treatment attitudes and beliefs
and knowledge of and experiences with OST. Data were transcribed, translated
into English and coded. Coded segments related to OST access, entry, knowledge,
beliefs and attitudes were analyzed among 41 PWIDs who were eligible for but
had never received OST.

Findings

A number of programmatic and
structural barriers were mentioned by participants as barriers to entry to OST,
including compulsory drug user registration, waiting lists, and limited number
of treatment slots. Participants also voiced strong negative attitudes and
beliefs about OST, especially methadone. Their perceptions about methadone’s
side effects as well as the stigma of being a methadone client were expressed
as obstacles to treatment.

Conclusions

Despite expressed interest
in treatment, Ukrainian OST-naïve PWIDs evade OST for reasons that can be
addressed through changes in program-level and governmental policies and
social-marketing campaigns. Voiced OST barriers can effectively inform public
health and policy directives related to HIV prevention and treatment in Ukraine
to improve evidence-based treatment access and availability.